43 :Hepatophilic virus disease – TCM classification as “Wetness-heat vaporization form” Common symptoms (10):Wetness-heat of lower-jiao – Stranguria, turbid urine, leukorrhea (I)

The various symptoms of “wetness-heat vaporization form” are the most common and typical symptoms of TCM classification of chronic hepatitis.  These symptoms appear during the entire course of chronic hepatitis up to the time of clinical cure of the disease by TCM treatment.

The mechanism and pathology of wetness-heat vaporization form not only can produce different disease and lead to different clinical symptoms but, promoted by infection of hepatophilic virus, it can also cause accumulation of “wetness-heat” in the body, and further, downward flow of “wetness-heat”, rendering the body to form “wetness-heat of lower-jiao” (下焦).  Attack from wetness-heat is enhanced by liver dysfunction which causes abnormal metabolism and poor detoxication ability and also by direct affection of pestilential evil on various organs of the body causing inflammatory reaction of mucosal tissues and consequently clinical symptoms of lower-jiao wetness-heat.  These clinical manifestations are “stranguria”, “turbid urine”, “leucorrhea” and difficulties in urination and defecation; they all belong to the field of “wetness-heat of lower-jiao” disease in TCM.

Clinically, the so called lower-jiao heat in TCM is caused by accumulation of heat through the flaring of fire in the gate of life as well as heat in the urinary bladder; the respective symptoms are difficulty in mieturition, dark urine, constipation, hematuria, dribbling urination and anuria.  The patient, although weak, has heat in the body and if the heat gues up, it becomes fire and if it runs down, it causes spermatorrhea.  The most common symptoms are urinary bladder wetness-heat, dysfunction of urinary bladder and leukorrheal disease.

(1)         Urinary bladder wetness-heat.

  The symptoms include :

¨             frequent urination (loss of control of urinary bladder, frequent alternation of shutting and opening  of bladder sphincter);

¨             dribbling and unclear urination (loss of gasification function in the kidney, kidney damaged by prolonged existence of five types of stranguria and turbid urine, dripping of urine in voiding, unsmooth urination);

¨             pain in micturition;

¨             burning sensation of urethra;

¨             post-urination dribbling,

¨             distensive pain of lower abdomen,

¨             dysuria and in severe cases even hematuria and anuria.

In the concept of TCM, there is difference between stranguria and urinary turbidity; urinary turbidity is mostly caused by toxin, while stranguria falls into the category of weakness.  Because the clinical manifestations of “lower-jiao wetness-heat” are extremely common, most physicians as well as patients do not recognize the relationship between “lower-jiao wetness-heat” and chronic hepatitis and also because these symptoms are rather concealed and not easily to be spoken of.  Sometimes, it is due to the mildness of the symptoms which may be neglected and so the disease may proceed for a long time without remedy.

Late stage liver disease patients mostly have damaged of yin and therefore, if there is urinary turbidity, toxin should be eliminated.  In case of stranguria, yin should be supplemented.  There is also difference in clinical management, but the TCM systemic treatment of “soothing the liver and relieve stagnation together with clearing of wetness-heat” in chronic hepatitis is indispensable.  If the liver is not completely detoxicated and wetness-heat not abolished, treatment of the fundamental cannot be attained and wetness-heat of lower-jiao would not be eradicated.

 

(2)     Dysfunction of urinary bladder

This is due to weakness of kidney causing exhaustion of body fluid and invasion of evil upon the urinary bladder where heat is accumulated and it reaches to an excessive height and finally turns into dysfunction of urinary bladder.  The symptoms include tenderness of the lower abdomen and the urinary bladder.

If the patient drinks water, the amount of urine is small and there is difficultly in urination, enuresis or appearance of a clear discharge.  If the gasification ability of kidney and urinary bladder is impaired, there may be anuria, obstruction of urinary passage and dribbling urination. Prostatic disease in the male should also be classified in the field of lower-jiao wetness-heat.

 

(3)     Leukorrheal disease:

This is also caused by wetness-heat.  The formation of leukorrheal disease in women is mostly due to the invasion of virus evil and if it persists for a long time, the belt channel is hurt causing wetness-heat to flow down to the uterus.  Another cause is injury of the liver that affects the spleen.  If the energy of spleen is not protected, it cannot regulate body metabolism as well as blood nutrition so that wetness is formed and it flows down to become whitish discharge.  Whitish substances may therefore flow out from the vagina from time to time and may take the form of nasal discharge or sputum, and because the illness runs a prolonged course, it is called leukorrheal disease.  The treatment of leukorrheal disease aims at clearance of liver and stoppage of stranguria; therefore, hepatophilie virus infection is also an important cause in the formation of gynecologic diseases.

 

Introduction of cases

Case 1

Lee (code number 1124) male, age 37 years.

He took his first visit on November 1994, having a history of type B hepatitis virus carrier for 10 years.  He also suffered from hemorrhoids with bleeding for nearly 20 years.  Recently, he was found to have chronic nephritis confirmed by biopsy and also positive B. coli in urine culture.  He felt weak and had also insomnia, repeated sorethroat, frequent micturition and distensive pain over the loins and lower abdomen.

Physical examination: tongue margin multiple ecchymotic patches, thin and whitish tongue coating, (+) pitting edema of lower extremities, abdomen distended, soft and tympanitic, lower margin of liver dulness 3cm above costal margin.  The tentative diagnosis was type B hepatitis, type B hepatic nephritis, wetness-heat of lower-jiao (stranguria, hemorrhoids complicated with bleeding).

After taking 3 parcels of TCM drugs, the lower margin of liver dulness was found to be 4.5 cm above costal margin; sleeping improved and frequency of urination decreased.  After another 3 parcels of TCM drugs, percussion of liver revealed hepatomegaly of 1.5 cm. Abdominal distension improved, hemorrhoidal bleeding stopped and there was marked regression of edema of lower extremities.

Another 15 parcels of TCM drugs (total 21 parcels) brought the liver dulness to normal.   In the meantime, clinical symptoms disappeared.  Clinical cure was attained after systemic TCM treatment for chronic hepatitis and thereafter TCM therapy was discontinued.

 

 

By WONG  Kwok Hung

published on  10th July 2001

(translated by Professor ZHENG Hua En in March 2003)